by Kate Alfano, CMS Communications Coordinator
Featured in the March/April 2019 Colorado Medicine.
Colorado Medicine sat down with Debbie Chandler, CEO of Matthews-Vu Medical Group, to talk about their efforts to contain costs. MVMG is a primary care practice with three locations in Colorado Springs and specialists in pediatrics, family medicine, internal medicine, behavioral health and dermatology. Their vision is to provide exceptional health care for children and adults, and they achieve this by investing time in their patients and focusing on providing quality care to improve health outcomes. As the practice grows, they look to continue to fulfill their mission to provide compassionate and individualized care for patients and their families.
CM: Where did you start in your efforts to address health care costs?
DC: Matthews-Vu currently cares for over 30,000 Medicaid patients in the Pikes Peak Region. Dedicated providers and clinical resources continuously work to improve Medicaid patient access to primary care and health outcomes, and control spending growth. We fully embody the medical home concept and provide integrated physical and behavioral health for our patients and their caregivers. When other primary and specialty care physician practices have closed to new Medicaid and Medicare patients, we have continued to accept new and attributed patients. Last year, we acquired a second practice and location in the primary care underserved region of downtown Colorado Springs; we have opened to new Medicaid patients and are providing unprecedented access. In early 2019, we acquired a practice in the Rockrimmon region and are focusing on improved access for Medicaid and Medicare.
CM: How did you come to be concerned about costs and why did you decide
DC: All indications from the federal and state governments indicate a continued shift in the way primary care physicians and other health care providers will be paid. New payment arrangements reward advanced, coordinated care for populations of patients, and provide incentives to improve quality outcomes (KPIs) for these populations and reduce the overall cost of care through appropriate reduction in utilization, emergency room and hospital visits. Our Population Health Department makes this possible and we believe Matthews-Vu Medical Group will be well positioned for this shift in reimbursement models.
CM: What other initiatives have you pursued to reduce costs to the patient and the system overall?
DC: MVMG has a comprehensive risk stratification process that is applied to all population health patients and documented in our patient registry. This includes giving a patient a calculated score (HCC correlation) based on health conditions, then applying clinical intuition to the score and placing the patient in a high-, moderate- or low-risk category. High-risk patients are engaged by phone or by direct contact when they are seen for an appointment. Case management is offered to the patient at this time and, if accepted, a comprehensive assessment and care plan is written with the patient’s input. These patients are discussed with the patient’s care team on a weekly or monthly basis to ensure their goals are being met. The minimum contact with each patient who is in case management is at least monthly with an RN Case Manager (4 FTEs), although these patients typically require more frequent outreach and contact.
Our three full-time care coordinators perform outreach to MVMG population health patients to schedule them for their annual wellness visits or to establish care with our practice when they show up on our attribution lists without having previously been seen. Annual wellness visits often help these patients achieve optimal wellness to prevent unnecessary ED visits and hospitalizations. Our care coordinators also prepare wellness visit information for our direct patient care staff to ensure all preventative screenings and tests are addressed. Then our care coordinators follow up after each visit is completed to ensure the ordered screenings and tests were completed.
CM: How does your practice arrangement as a multi-specialty group assist in your cost-containment efforts? Could other practices (solo, small group, physician-owned, hospital-owned, etc.) adopt these strategies?
DC: Each MVMG patient that visits the emergency department or who has an inpatient stay is contacted by our PHM staff within two business days from the time of discharge. Our case managers obtain discharge information daily from each hospital’s electronic medical record system so there is no lag in our office receiving discharge information. During these calls we talk with the patient about discharge instructions, perform a medication reconciliation and schedule a follow-up visit, usually within two weeks, to ensure they are not re-hospitalized, and they are safe until they are seen by their MVMG PCP. Through patient education and follow up, we have seen a quarter-over-quarter documented decrease in our ED/inpatient utilization.
For those patients who do not qualify for longitudinal care management, our case managers spend many hours finding resources and coordinating care for MVMG patients. This could be anything from transportation to housing, psych services, addiction support, medication management, advanced placement, Department of Human Services, etc. We provide a very comprehensive service to this population of patients. Our case managers often spend several hours searching for resources and advocating for this population of patients.
CM: What have you learned from your experiences that would be valuable to other groups who may or may not be addressing health care costs?
DC: It is important to be aware of the many ongoing changes in health care. We consistently monitor health care costs, trends and service lines. Being proactive rather than reactive has been a valuable tool for MVMG.